Wednesday, February 22, 2006

A dose of medicine

I have this little piece of paper I carry around with me that lists the books I intend to read for when I’m in a library or bookstore. I used to use my PDA, but now that I have a Windows piece o’ crap at work and a Mac at home, this became too difficult, but that’s a rant for another day. Anyway, I checked a book out of the library a few weeks ago that had been on my list for a long time -- so long that I have no memory of where I heard about it. No matter; it was one of the best I’ve read in a long time: My Own Country by Abraham Verghese. It’s a doctor’s first-person account of how AIDS began to manifest itself in a small town in Tennessee where he worked in the 1980s.The way he interweaves medical information, his patients’ stories and snippets of his own life was fascinating and moving. Turns out he wanted to be a journalist as a kid but chose medicine after reading Of Human Bondage.I was so taken with this guy that I looked for more stuff about him and discovered this interview in which he discussed the role of doctors and modern medicine. This part really rings true:I suspect that the challenge for doctors in the next century will be to rediscover why the profession was once called the "ministry of healing," to rediscover why medicine was at one time a calling and not a particularly lucrative one at that. People who visit doctors are looking for more than a cure, they are looking for "healing" as well. To understand the distinction between "healing" and "curing," let me use an analogy: If you have ever been robbed, and if the cops came back an hour later with all the stuff taken from your home, you would be "cured" but not "healed" -- your sense of spiritual violation would still remain. In the same way, all illnesses have these two components: a physical violation and a spiritual violation. Years ago, when there were very few effective medications, the horse-and-buggy doctor by his or her presence at the bedside, often for extended periods, could bring about a healing (by which I mean helping patients come to terms with their illness) even when the disease was fatal. As Western medicine has become better at dispensing cures, the healing aspect has suffered. I think the public is much more willing to seek out alternative medicine and practitioners of alternative medicine because they recognize that Western medicine has become caught up in the conceit of cure, with no time for the spiritual violation of illness. I think the burden will be on doctors to rediscover the lost art that our predecessors of a century ago were so good at. Before the days of antibiotics and ICUs, the medical experience was very different for both doctors and patients. As John M. Barry notes in “The Great Influenza,” until the late 19th century, medical schools in the United States did not require a high school diploma and accepted anyone who could pay, and doctors didn’t earn squat. Today, many people go into medicine for the money and prestige, the allure of the science or the thrill of performing a complicated procedure. Maybe it’s too much to ask modern doctors to learn the mind-boggling and exponentially growing amount of scientific stuff they need to know and also expect them to be true humanists. And the process of medicla education and residency stomps out of lot of the time-spending and compassion that used to be part of the trade (see House of God -- funny and bitter, a la M*A*S*H).